A Quantitative Prospective Study for Whole Body- Diffusion MRI and PET-CT in Detection of Primary and Metastatic Malignant Lesions
Date
2022-05-22
Authors
Ahmed Mohammed Ahmed Abu Ali
أحمد محمد أحمد أبوعلي
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
فكرة وجود وحدة طب نووي متكاملة تتكون من جهاز ماسح مع مصدر للنظائر المشعة مثل المسارع النووي الدائري للعمل بكفاءة في فلسطين يكاد يكون مستحيلًا بسبب العديد من القضايا التي تبدأ من القضايا السياسية وتنتهي بالقضايا المالية بسبب الإحتلال الإسرائيلي.
الهدف من هذه الدراسة هو إيجاد طريقة آمنة وصالحة ومتاحة على نطاق واسع كبديل للتصوير البوزيتروني الطبقي لمساعدة أطباء الأورام وكذلك المرضى ، اقترحنا بروتوكول نموذجي معدل للرنين المغناطيسي لتصوير الجسم بالكامل (WB-DWI MRI) لاستسغلال خاصية الإنتشار من جزيئات الماء داخل انسجة الجسم.
شارك 33 مريضًا من مرضى الأورام بهذه الدراسة ، 60٪ ذكور (20) و 40٪ إناث (13) ، تتراوح أعمارهم بين 18-74 عامًا بمتوسط عمري 48 عامًا ومتوسط وزن جسم 83 كجم .
تم تشخيص إصابة المشاركين بالفعل بأورام أولية بما في ذلك سرطان الغدد الليمفاوية اللاهودجكين،و سرطان الغدد الليمفاوية هودجكين ، سرطان الرحم ، والبروستات ، والبنكرياس ، والمعدة ، والغدة الدرقية ، والكسور المرضية ، والكُتل الجلدية.
أظهرت نتائجنا أن التصوير المقطعي بالإصدار البوزيتروني أظهر 181 كتلة ذات نشاط حيوي عالي في المناطق الأربع (الرأس والعنق، الصدر، البطن والحوض، والجهاز العضلي الهيكلي) لجميع المرضى ، تم اكتشاف نفس الكتل بواسطة WB-DWI MRI الذي يُظهر معظم الكتل نفسها مقيدة في الانتشار بالإضافة لكتل لمفاوية ذات حجم أقل من 1سم بعدد إجمالي 251 كتلة مع مقارنة بين حجم الامتصاص القياسي (SUV) ومعامل الانتشار الظاهر ADC حيث تبين أن الكتل ذات حجم الإمتصاص القياسي (SUV> 2.5) كان معامل الإنتشار الظاهر لها ADC أقل من 1.1 × 10-3 مم 2 / ث.
يُظهر التحليل الكمي الإحصائي ارتباطًا إيجابيًا معنويًا بين عدد الكتل المكتشفة باستخدم الرنين المغناطيسي والتصوير البوزيتروني في نفس المنطقة لكل مريض بدلالات إحصائية موزعة كالتالي:
0.178 و 0.434 و 0.606 و 0.840 للرأس والعنق والصدر والبطن والحوض والجهاز العضلي الهيكلي على التوالي ، ويظهر الارتباط المقارن بين ADC و SUV وجود ارتباط سلبي بقيمة p <0.05 وقيمة
R = -0.3073. يمكن أن يحل التصوير بالرنين المغناطيسي WB-DWI محل التصوير المقطعي بالإصدار البوزيتروني في حالات سرطان الغدد الليمفاوية ومتابعة الأورام لمراقبة الاستجابة للعلاج بعد العلاج الكيميائي أو العلاج الإشعاعي وكذلك الأمر بعد عمليات الإستئصال الجراحي.
The idea of having an integrated nuclear medicine unit consisting of a scanner with a compatible source of isotopes like cyclotron to work efficiently in Palestine is almost impossible due to many issues beginning from political issues and ending with financial issues. Moreover, the nature of materials that have been used in nuclear medicine is radioactive which could increase the ability of causing other malignancies. PET scan can sometimes show areas of high activity, which may be mistaken for cancers like inflammatory conditions. In order to avoid all these pitfalls that might interfere with the diagnostic process, it is necessary to start looking for an alternative to support oncologists and their patients to use another safe, valid, available in abundance and lower cost technology called Whole Body Diffusion MRI. It can project areas of restricted water diffusion for pathologies and for tumors through the whole body in places where cellular activity is increased with decreasing of relevant water diffusion in the same area. A prospective data collection for 33-oncology patient, who advised previously to do PET scan had been agreed to participate in our study for WB-DWI MRI scanning in a period not exceeding ten days between PET and MRI. 60% are male participants (n=20) and 40% female (n=13), ages of participants are ranging between 18-74 years old with an age average of 48 years old, body weight average is 83kg with a maximum and minimum weight are125kg and 56kg respectively. Their primary diseases varied between non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, endometrial, prostate, pancreatic, and gastric, thyroid cancer, pathological fracture and skin lesions. Result in PET shows 181 hypermetabolic lesion distributed in the four zones (head-neck, chest, abdomen-pelvis and musculoskeletal). WB-DWI MRI shows most of the same lesions restricted in diffusion with extra small subcentimetre lesions totally 251 lesions in count. Comparison between standard uptake volume (SUV) and apparent diffusion coefficient ADC) which shows most high SUV (SUV>2.5) have ADC < 1.1 x10-3 mm2/s. Statistical quantitative analysis shows a significant positive correlation between number of detected lesions in both modalities, in the same zone for each patient, at p value < 0.05 (p=0.00004) and R-value = 0.178, 0.434, 0.606 and 0.840 for head-neck, chest, abdomen-pelvis and musculoskeletal respectively. A comparative correlation between ADC and SUV shows a significant negative correlation between SUV and ADC at p value < 0.05 and R-value= -0.3073. WB-DWI MRI can be used in some lymphoma cases for follow up as an alternative for PET scan in case no access is available for PET imaging, DWI can be used also for localized tumors follow up to monitor the response for treatment after chemotherapy or radiotherapy either post-surgical resection. Oncology and radiology departments recommended activating diffusion sequence in each MRI study for oncology patients in order to assure the idea of diffusion restriction for follow up studies
The idea of having an integrated nuclear medicine unit consisting of a scanner with a compatible source of isotopes like cyclotron to work efficiently in Palestine is almost impossible due to many issues beginning from political issues and ending with financial issues. Moreover, the nature of materials that have been used in nuclear medicine is radioactive which could increase the ability of causing other malignancies. PET scan can sometimes show areas of high activity, which may be mistaken for cancers like inflammatory conditions. In order to avoid all these pitfalls that might interfere with the diagnostic process, it is necessary to start looking for an alternative to support oncologists and their patients to use another safe, valid, available in abundance and lower cost technology called Whole Body Diffusion MRI. It can project areas of restricted water diffusion for pathologies and for tumors through the whole body in places where cellular activity is increased with decreasing of relevant water diffusion in the same area. A prospective data collection for 33-oncology patient, who advised previously to do PET scan had been agreed to participate in our study for WB-DWI MRI scanning in a period not exceeding ten days between PET and MRI. 60% are male participants (n=20) and 40% female (n=13), ages of participants are ranging between 18-74 years old with an age average of 48 years old, body weight average is 83kg with a maximum and minimum weight are125kg and 56kg respectively. Their primary diseases varied between non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, endometrial, prostate, pancreatic, and gastric, thyroid cancer, pathological fracture and skin lesions. Result in PET shows 181 hypermetabolic lesion distributed in the four zones (head-neck, chest, abdomen-pelvis and musculoskeletal). WB-DWI MRI shows most of the same lesions restricted in diffusion with extra small subcentimetre lesions totally 251 lesions in count. Comparison between standard uptake volume (SUV) and apparent diffusion coefficient ADC) which shows most high SUV (SUV>2.5) have ADC < 1.1 x10-3 mm2/s. Statistical quantitative analysis shows a significant positive correlation between number of detected lesions in both modalities, in the same zone for each patient, at p value < 0.05 (p=0.00004) and R-value = 0.178, 0.434, 0.606 and 0.840 for head-neck, chest, abdomen-pelvis and musculoskeletal respectively. A comparative correlation between ADC and SUV shows a significant negative correlation between SUV and ADC at p value < 0.05 and R-value= -0.3073. WB-DWI MRI can be used in some lymphoma cases for follow up as an alternative for PET scan in case no access is available for PET imaging, DWI can be used also for localized tumors follow up to monitor the response for treatment after chemotherapy or radiotherapy either post-surgical resection. Oncology and radiology departments recommended activating diffusion sequence in each MRI study for oncology patients in order to assure the idea of diffusion restriction for follow up studies